The news isn’t good for Arkansas Works. Reports are showing that over 18,000 people have lost coverage so far.
People have to work or report some exemption as a reason that they can’t work, like if they have a disability or a kid at home. If they don’t report 80 hours of work a month, for 3 months in a year, they get kicked off.
What do you think about this? Let us know!
If you have lost coverage, you can contact Legal Aid of Arkansas for help! Call 870-732-6370 ext 2206.
Big news this week in case you missed it. There were 4 PASSEs, and now there are 3. ForeverCare says they can’t move forward, right before the PASSEs would all receive the payment to manage everyone’s care on March 1. What does this all mean? Now what?
The news has covered this some in the past few days. Forevercare says the program isn’t ready, but DHS says they are. Watch this video or read this news story to see what ForeverCare had to say:
If you don’t know what the PASSE is, check this out (MSL Resource).
Or watch this previous town hall recording from DHS.
They’re supposed to take our complaints, concerns, and help us solve problems:
Call – 1-844-843-7351 (during business hours)
Email – PASSEOmbudsmanOffice@dhs.arkansas.gov
More info – https://humanservices.arkansas.gov/about-dhs/dms/passe-ombudsman If you’re a provider, and you’re confused or concerned about all of this and how it will work before March 1, you need to contact DHS through
Tanya Giles | tanya.giles@dhs.arkansas.gov | 501-320-6189
Keep them up to date on how this system is affecting you.
Contact our state legislators.
Contact any elected legislator in the US.
See how your local Representatives or Senators voted on Act 775.
If you are a ForeverCare family, they are going to be your PASSE until March. Even after you’re reassigned, your new PASSE isn’t supposed to officially take over until March 1. But your new PASSE will be contacting you to give you more information, find out more about you and everything you need. So make sure you don’t forget ForeverCare’s contacts.
That means you’ll have until May to decide if you like your PASSE, and if you don’t, you’ll have to research which one you want to go to.
Here is the other PASSE information. You need to check out their handbooks and networks. Ask other families what they like and don’t like about their PASSEs.
Some of them are having family and provider meeting this month. Call them to find out when theirs is!
CEO, John Ryan – jryan@centene.com
Care Coordination Contact: Amber Baker | (501) 478-2597
Amber.Baker@ArkansasTotalCare.com
NETWORK LIST – none shown on website
CEO, Nicole May – nicole.may@beaconhealthoptions.com
Care Coordination Contact: Jamie Ables | Office (501) 707-0961
Jamie.Ables@beaconhealthoptions.com
CEO, Jason Miller – jason.miller@summitcommunitycare.com
Care Coordination Contact: Tiffany Parkhurst | (501) 773-6273
Tiffany.parkhurst@summitcommunitycare.com
This is what DHS had to say to our questions as of Jan 18:
The PASSE Ombudsman is supposed to be there to help us when our PASSE isn’t.
These are people employed by DHS, not by the PASSEs.
If you have a complaint against your PASSE, your care coordinator, your Independent Assessment Tier, or if something just isn’t getting solved, you might want to try calling the Ombudsman. Call 1-844-843-7351 if you need help.
Here’s an AR Choices update from our friends at Legal Aid Arkansas:
Latest ARChoices update. Last Monday (12/10), the first legislative committee–which didn’t have the power to say no–reviewed the proposed changes to the ARChoices program and sent them on to a second legislative committee, which is called the Rules and Regulations committee. This second committee has the power to say no to the rules (in some circumstances).
THE SECOND COMMITTEE MEETS on Tuesday, 12/18, at 1 p.m. in Room A of the MAC Building in Little Rock. Members of the public have the right to speak. People were limited to two or three minutes at the first committee and were pressured to get straight to the point.
Based on what DHS said at the meeting, media reports, and questions I’ve received from clients, here’s some important information.
(1) ACTUAL CARE HOURS. Our clients’ main concern is getting enough care. Almost 90% of the people on ARChoices use agencies for their care. The remaining people hire their own caregivers (it’s called “self-directing” care; you know you self-direct if you go through Palco; self-directing people may be able to get more hours). For everyone who uses agencies, the absolute maximum number of hours you can get under the new rules is 6.5 hours per day (46 per week) based on the hard budget limit of $30,000 per person per year. We know that is not enough for many of our clients.
6.5 hours per day (46 per week) is the best-case scenario. From experience, we know that the best-case scenario isn’t usually what happens. There are several things that can take away from this.
(A) The first thing that can take away hours is the new Task and Hour Standards, which will allocate a set amount of time for each activity of daily living you need done. Using algorithms, DHS will assign you a severity score in each key ADL. Then, based on that severity score, you can get a certain number of minutes for each activity. For example, if you score a 3 on bathing (3 is the most severe), the DHS nurse can give you between 35 and 45 minutes. DHS does that for each ADL (food prep, eating, dressing, grooming, cleaning, etc.) and then adds it all up. If this comes out lower than 6.5 hours per day, you can only get the number of hours the Task and Hour Standards allows. If that comes out higher than 6.5 hours per day, you can still only get the 6.5 that your budget allows.
(B) The second is if you use other services like home-delivered meals, the personal emergency response system, or respite care. The cost of these things comes out of your budget. IF YOU GET ONE MEAL FIVE DAYS PER WEEK AND HAVE THE EMERGENCY RESPONSE SYSTEM, YOU WILL LOSE ABOUT TWO HOURS OF CARE PER WEEK. And, every hour of respite care you choose means a loss of one hour of attendant care.
(C) The third is if you do not get placed in the budget category of $30,000 per year. There are two other budget categories–one with a $20,000 limit per year and one with a $5,000 limit per year. People in the $20,000 category will only be able to get up to 5 hours per day (36 hours per week). People in the $5,000 category will only be able to get up to 3 hours per day (20 hours per week). Algorithms will determine budget placement.
(2) POSSIBLE ALTERNATIVES. While Legal Aid does not advocate for specific policy fixes, we can analyze factual information and consider alternatives. Our clients’ main concern is getting enough care. We don’t have access to detailed DHS data that would allow for precise calculations, but we can make reasonable assumptions.
SCENARIO ONE. If DHS raised the $30,000 yearly cap to $36,000, it would give people a possibility of 1 more hour of care each day (so, 7.5 total per day, which is 53 per week) and would probably cost less than $1,500,000 total to the budget per year. Based on DHS’s estimates, about 260 people received services this year that cost more than the $30,000 cap. Those people will already be “grandfathered” into the new system and should be accounted for in DHS’s current budget. The extra cost of $1,500,000 assumes another 260 people will need services that cost more than $30,000 per year. This extra 260 people seems like a reasonable estimate. There could be people already on the program who face increased needs (DHS estimated 206 people this year required services that cost between $25,000 and $29,999, so some of them might need more as conditions worsen) or people who come onto the program with higher needs than the people they are replacing. There could also be a few of the grandfathered people who would get a slight bump under an incrased cap (147 people got services that cost between $30,000 and $34,999). And, that $1,500,000 assumes that all of the people who qualify for the increased budget cap will actually receive all $36,000 of services.
***REMEMBER, the increased budget doesn’t automatically mean more hours. The actual hours will be limited by the Task and Hour Standards.
SCENARIO TWO. If DHS raised the $30,000 yearly cap to $39,000, it would give people a possibility of 1.5 more hours of care each day (so, 8 total per day, which is 56 per week, which was the maximum under the system of nurse discretion that existed before RUGs) and would probably cost less than $2,340,000 total to the budget per year. Again, this assumes that 260 people will need services that cost more than $30,000. The 260 people could include some of the 206 people who received services costing between $25,000 and $29,999, some of the 147 people that got services costing between $30,000 and $34,999, some of the 74 people that got services costing between $35,000 and $39,999, and some new people.
***REMEMBER, the increased budget doesn’t automatically mean more hours. The actual hours will be limited by the Task and Hour Standards.
Even with higher budget limits, THE COST OF HOME-BASED CARE IS FAR LESS THAN THE COST OF NURSING HOME CARE. The $39,000 cap comes out to $3,250 per month, and the $36,000 cap comes out to $3,000 per month. By DHS’s own estimates, nursing home care costs around $5,500 per month.
(3) The Proposed System Still Uses ALGORITHMS That Will Be Hard for People to Understand. DHS is publicly saying that the proposed system doesn’t use computer algorithms. This is demonstrably false. DHS has to use algorithms to turn the answers to the 400+ questions on the assessment into placement in an eligibility tier, a budget category, and scores for the ADLs on the Task and Hour Standards. While the new algorithms will work differently than the RUGs algorithm, they are still algorithms. People will probably still have a hard time understanding why they get a particular amount of care.
(4) The Proposed System Could VIOLATE THE AMERICANS WITH DISABILITIES ACT. Some people have heard of the Olmstead case. It was a Supreme Court case that stands for the idea that a state discriminates against people with disabilities if the state’s actions put people at risk of institutionalization. Using a hard budget limit to deny services that are needed for people to be able to stay at home violates the ADA.
(5) The “Flexibility” DHS Has Proposed Doesn’t Address the Issue of Budget Caps. DHS will allow nurses some modest discretion in completing the Task and Hour Standards, but this DOES NOT allow nurses to adjust the hard budget cap. So, even if the nurse uses their discretion to say that you need 8 hours a day of care on the Task and Hour Standards, you cannot get that much if your budget doesn’t allow it. If you need more than $30,000 in services, there is a one-time exception possible for “exceptional, unexpected circumstances” like the death of a caregiver or drastic change in condition but not for people whose regular care requirements involve more than that (i.e. if you are relatively stable, no exception is possible). And, to get this limited exception, you have to go through a DHS review panel–it is NOT in the discretion of the nurse.
NOTE: If you currently receive more than $30,000 in services, you will be “grandfathered” into the new system and get to keep up to your current services next year (your current level will be your budget cap). However, your hours could still go down based on the Task and Hour Standards.
As always, please feel free to write or call me with any questions. 870-732-6370 x 2206.
This holiday season, you can make an impact with 2 simple words: Thank you.
Especially if you’re a Medicaid recipient, let the people in charge know that we need Medicaid, and let them know what it does for us. Tell them thank you, and ask them to keep directing funding to Medicaid. Send them a photo of the person who is helped by Medicaid.
This is what advocacy is. It’s so easy! Just speak up for what matters to you.
Here’s how:
other contact: governor.arkansas.gov/online-services/contact-us
Email any State Congressperson
This is a long but important update from Kevin deLiban of Legal Aid of Arkansas on information about the NEW SYSTEM to determine hours for ARChoices that DHS will start using on January 1, 2019.
The public comment period is open until 11/7/18, and public meetings will be held from now until then.
(1) RUGs Update. Late Monday, the judge dissolved the injunction against RUGs, meaning that DHS will start allocating attendant care to new applicants for the program and will also re-assess people whose plans of care have expired. RUGs will only go back into effect for the next two-and-a-half months and then will be replaced by the new system described below. If anyone faces reductions because of RUGs during that time, they can call Legal Aid of Arkansas at 800-967-9224. We don’t anticipate more court challenges against RUGs (though that can always change), but we may be able to help with administrative appeal hearings.
Due to the hard work of people on the program, caregivers, attorneys (at Legal Aid of Arkansas, the Center for Arkansas Legal Services, and Disability Rights Arkansas), case managers, care agencies, journalists, and others, RUGs is definitely going away (DHS had no plans to switch to a new system before the litigation and public attention), about a thousand people avoided devastating RUGs-based cuts for several months (and at least couple dozen people kept their pre-RUGs hours for a year or longer), 150+ people with cerebral palsy are getting more hours than they otherwise would have due to discovery of a DHS software error, hundreds of people (including legislators and the wider public) have learned more about Medicaid home-care services and the importance of a fair system to determine hours, and a community of people are now activated around these issues. Justice only exists because people work to create it. Grateful for all of you who did so here. We lost along the way, too, and I think about the clients who passed away fearing or fighting cuts, clients who’ve been living with the cuts, and all the suffering we couldn’t stop. They keep me motivated.
(2) The New System. DHS finally released details of the new system it plans to use starting January 1, 2019. DHS’s own summary of the changes are attached. There is A LOT of information in here, so I’ll go through the major items.
• New Assessment. Up to now, DHS was using the assessment tool known as ArPath, which had 286 questions. ArPath will be going away. The new assessment will be called ARIA and could have as many as 400 questions. It will be performed by a Registered Nurse who works for a private company named Optum. After the Optum RN comes out to do the assessment, the results will be sent to DHS for a determination about eligibility, the amount of hours someone gets, and what budget category someone fits in. This involves a separate visit by a DHS RN to do the care plan.
Questions/Unknowns:
~ Will people be given enough advance warning in order to get medical records or arrange for caregivers to be present so that the information in the assessment is accurate?
~ Will the new assessment take longer than the old assessment, which already took 60 to 120 minutes? Will the questions be understandable, relevant, and fair?
• New Hour Determination System. RUGs used an algorithm that mixed a lot of different factors that didn’t seem to make obvious sense in order to place someone in a group with a fixed number of hours. The new system will be very different. It is called the “Task and Hour Standards.” Based on the ARIA assessment, an algorithm will rank each person from 0 to 3 in each key Activity of Daily Living (bathing, dressing, feeding, grooming, toileting, transferring, walking, cleaning, laundry, meal preparations, and shopping). Then, based on whether you get a 0, 1, 2, or 3, the DHS nurse (who comes in a separate visit from the Optum nurse) will determine how many minutes you get for that particular activity. For example, if you score a 3 on bathing, the DHS nurse can give you between 35 and 45 minutes. If you score a 2, the DHS nurse can give you between 15 and 30 minutes. If you score a 1, the DHS nurse can give you between 5 and 10 minutes. The DHS nurse will then figure out how many times per week you need to do a particular task. The DHS nurse will then add up all the minutes you get for each ADL and give you a monthly number of hours.
Questions/Unknowns:
~ DHS hasn’t said how the algorithm will figure out if you are a 1 or 2 or 3 for any particular ADL.
~ DHS hasn’t stated the frequency that certain tasks will be allowed. Is bathing a daily task? Do people get to be dressed twice per day (once into the day’s clothes; once into bedtime clothes)? Will the frequencies allowed match actual care needs?
~ DHS has said that the time given will be reduced by the amount of time that family, friends, or others do that same task voluntarily. It is not known how this will affect people with family caregivers.
~ DHS has said that no time will be given for the cleaning of shared spaces when the caregiver lives with the beneficiary. There could be other reductions for people who live with their caregiver.
~ DHS has said that nurses can request to go outside the amount of time allowed if there are “extenuating circumstances” and the nurse receives supervisor approval. For example, this means someone may be able to get 55 minutes for bathing even though the highest amount officially available is 45 minutes. BUT, these adjustments might not mean much because of the budget limits described below.
~ Even if you are allowed a particular amount of hours under the Task and Hour Standards, you might not actually get that number of hours because of the new overall budget limits described below.
• New Overall Budget Limits. DHS is doing something it has not done before in ARChoices, AAPD, or Elder Choices. It is setting a hard budget cap for services an individual on the program can receive, regardless of the amount of care DHS’s own Task and Hours Standards says someone needs. There are three budget categories–Intensive, Intermediate, and Preventative. An algorithm will use the answers to the assessment to put you into one these three groups. People in the Intensive group can get no more than $30,000 worth of services in a year ($2,500 in a month). People in the Intermediate group can get no more than $20,000 worth of services in a year ($1,667 per month). People in the Preventive group get $5,000 in a year ($417 per month).
So, even if the Task and Hours Standards states that you need 200 hours in a month, you cannot get those 200 hours if they cost more than is allowed by your budget limit. For example, your budget limit might only allow you to “buy” 150 hours per month (or some other number less than 200).
Questions/Unknowns:
~ DHS has not stated the actual price of the services so that you can predict the number of hours actually possible under the budget limits. However, if you take the standard attendant care rate of $18 per hour, the highest budget level (Intensive, which allows $2,500 per month), would only allow 139 hours per month. This would not be enough for many people. The next highest budget limit (Intermediate, $1,667 per month) would only allow 93 hours per month (at the rate of $18 per hour for attendant care).
~ DHS has stated to media that the cost of attendant care would be less for people who hire their own caregivers instead of using an agency (meaning they could possibly get more hours under the budget limit), but that would seem to give far fewer hours to people who use agencies than people who hire their own caregivers.
~ DHS has stated to media that up to 64 hours of personal care hours may be available apart from this, but that is not confirmed in policy and may still not be enough care for many people who have higher needs.
~ DHS’s process to arrive at these $30,000/$20,000/$5,000 categories has not been independently verified to be reliable. These amounts could be arbitrary. DHS says they are based on the cost of nursing home care, but DHS has given other figures that state nursing home care costs much more than $30,000 per year (these other DHS estimates have put the cost of nursing homes at more like $60,000 per year).
~ DHS did not include in the public documents anything about how the budget limits will actually affect people. How many people will be put into each category? How many people will face cuts because of placement in a particular category?
~ DHS has stated that ARChoices beneficiaries who were on the program in 2018 and who received more than $30,000 in services will not face a cut due to the budget limits the first year. Instead, their budget limit will be the cost of the services they received in 2018. This is known as “grandfathering” people into the program. So, people with higher needs may be able to keep what they got in 2018 if the Task and Hour Standards determination shows they need that many hours.
~ Apart from the “grandfathering,” DHS has stated that the budget limit can be temporarily adjusted upward for one year through an “exceptions process” for “exceptional, unexpected circumstances.” DHS stated that these “exceptional, unexpected circumstances” might include the death of a caregiver or recent release from a facility.
• Will the new system provide enough care? Compared to the system of nurse discretion, RUGs was harmful to our clients because it meant huge cuts in hours for so many people, especially people with the most severe needs. It is not clear if the new system will give people any more hours than RUGs did. It is not clear if the new system will give people enough hours to meet their actual care needs and keep individuals out of nursing homes. DHS has stated that the changes will cut Medicaid spending by about $10 million the first year and about $14 million the second year. If spending cuts are the goal, increased care may not be part of the plan.
• Is it understandable? RUGs involved 20 pages of computer code that didn’t make sense to our clients. The new system seems to be complicated in a different way. First, people will have to figure out how the 400-question assessment turns into a score for each ADL on the Task and Hour Standard (how many minutes you get for each ADL). And, we don’t know if that will make sense. Second, people will have to figure out how the assessment turns into a Budget Limit category. Some people may be qualified for hours under the Task and Hour Standard that they can’t actually get because of the Budget Limit category. These complications may mean that people on the program may not be able to fairly contest decisions about the care they are allotted.
(3) Public Comment. Anyone can participate in the public comment process. Comments can be sent by email to becky.murphy@dhs.arkansas.gov or by mail to Office of Policy Coordination and Promulgation, P.O. Box 1437, Slot S295, Little Rock, Arkansas 72203-1437. Comments must be submitted by 4:30 p.m. on November 7.
(4) Public Meetings. Public comment will also be accepted at public meetings. The meetings are at the following times and places. Some of these meeting places are different from the meetings about ARChoices that were held in summer.
• Fort Smith, 10/15, 5 p.m., Arkansas College of Osteopathic Medicine, 7000 Chad Colley Blvd
• Monticello, 10/18, 5 p.m., Drew Memorial Hospital Conf. A., 778 Scoggin Dr.
• Hope, 10/22, 5 p.m., UA Hope Hempstead Hall, 2500 South Main St.
• Little Rock, 10/29, 5 p.m., Arkansas Enterprises for the Developmentally Disabled, 105 E Roosevelt Rd
• Jonesboro, 11/7, 5 p.m., St. Bernard’s Medical Center Auditorium, 225 E. Jackson Ave.
(5) Copy of the Full Materials. I could not cover all the changes being made. The full materials can be downloaded here. The full materials have information on other important changes being made to this program, Independent Choices, and the Assisted Living waiver program. For example, the rates of Assisted Living providers are facing significant cuts, which may mean that fewer people can get into an assisted living facility and more people may have to choose a nursing home instead.
This update was provided by Kevin De Liban of Legal Aid. If you have questions, please feel free to reach out to him:
Kevin De Liban, Attorney
Economic Justice Practice Group Leader
Legal Aid of Arkansas–West Memphis
310 Mid-Continent Plaza, Suite 420
West Memphis, AR 72301
Phone: (870) 732-6370 x. 2206
The RUGs has not proven to be holistic in assessing the needs of the patients. Your presence here today has not fallen on deaf ears and, moving forward, because of your intense pressure, it is duly noted that RUGs is not the system we want serving the needs of Arkansans with disabilities. I believe it would be fair to say that you have the attention and the ears of the legislative branch to assure that your needs are moving forward. While we may not agree 100% on everything, the one thing we know is we can’t stay where we are. And while this process continues out after we do our duty today, then we will work to make sure that we don’t revisit this chapter again.
Contact:
The 2 graphics below are of a letter that is going out to ARWorks beneficiaries who had their coverage closed last week. It contains options for them going forward.
Also, DHS posted many of their notices and letters that have gone out here: https://ardhs.sharepointsite.net/ARWorks/Notice_Samples/Forms/AllItems.aspx
This is a letter that went out to beneficiaries who received services at PFH to notify them of PFH’s closure. Some of you may be interested in this information as well as this link which lists the available providers. Please note the PDF is searchable!
This is an update from Kevin De Liban from Legal Aid of Arkansas. He wants to help us understand the latest on ARChoices.
Just a quick update on yesterday’s meeting in the legislature. The Public Health committee gave the RUGs algorithm an unfavorable review, meaning that the committee thinks that DHS should not adopt the RUGs algorithm. At least 4 people on the ARChoices program were present and testified before the legislators, as well as parent caregivers, advocates, case managers, and care agencies. These voices–especially the people on the ARChoices program–let the legislators know the details about how the RUGs algorithm has hurt many beneficiaries. Here is a newspaper article about the meeting.
That is not the end of the process. The RUGs algorithm now goes to the Rules and Regulations Subcommittee on Tuesday, September 18, at 1 p.m. in Room A of the MAC Building. The agenda includes a list of the legislators on the committee as well as other details.
Public comment will be accepted at this meeting. If the Rules subcommittee votes against the RUGs algorithm, it should be the end of it. But, there are some technicalities involved, and I have no way of knowing what the likely outcome is. Whatever happens, it’s inspiring to see how all sorts of people in different situations have been working in their own ways for justice on this issue.
How to contact Kevin with concerns or questions:
Medicaid Saves Lives 